We read with great interest the article on body packer syndrome by Kulkarni et al., published in the July-September issue of 2012. [1] We wish to highlight an important radiological sign, share our experience, and add data on the management of these patients.

The sign seen on the X-ray is known as 'double-condom sign'. This sign is due to the air trapped in the individual layers of packing material. [2] This sign is said to be a diagnostic criterion of body packer syndrome. Computed tomography (CT) has an advantage over plain radiographs, especially in those regions where the drug-filled packets maybe confused with formed feces.

Recently, we encountered a similar case of a body packer arrested by custom officials of Delhi International Airport. A 36-year-old foreigner was brought by custom officials and admitted to the Emergency Department. At admission, the patient was alert, co-operative, and asymptomatic. His medical history was uneventful, and vital signs and physical examination were normal. A plain X-ray of the abdomen was done which revealed numerous oval-shaped radio-opacities loaded in the rectum and colon which were delineated by a thin rim of a crescent of air [Figure 1]. Laxatives and bowel irrigation were given to clear bowel contents. Twelve packets of cocaine were recovered [Figure 2].

The main objective of treatment in these cases is to promote clearance of cocaine packets in the shortest time possible without causing any physiologic upset. This can be achieved by giving a wide range of laxatives and promotility agents. Liquid paraffin is contraindicated as it can cause deterioration of latex-based packets, resulting in rupture of the packets. [3] The current treatment of choice is whole-bowel irrigation with polyethylene-glycol at a rate of 1.5 L/hour orally, until all packets are passed. Bowel irrigation is contraindicated in the presence of bowel obstruction, bowel perforation, gastrointestinal hemorrhage, and hemodynamic instability. The absolute indications for surgery are signs or symptoms of cocaine intoxication or evidence of bowel obstruction. [4]